Mortality and morbidity associated with misdiagnosis of ectopic pregnancy in a defined Nigerian population

Abstract

Ectopic pregnancies can be very difficult to diagnose at initial admission. This paper reviewed the morbidity and mortality associated with misdiagnosis of ectopic gestation over a 15-year period (1985-99) at Ile-Ife, Nigeria. There were 380 confirmed ectopic pregnancies of 35 857 live births, giving an incidence of 10.5 per 1000 live births. Of the 380 cases, 38 (10%) were misdiagnosed initially at presentation. Mistaken diagnoses include pelvic inflammatory diseases, cholera, acute appendicitis, typhoid enteritis, incomplete septic abortion, uterine fibroid with menorrhagia, malaria, gastroenteritis, peptic ulcer and intestinal obstruction. There were five maternal deaths among the 38 misdiagnosed cases compared to two maternal deaths among the 342 initially correctly diagnosed cases. Significant morbidity included prolonged hospital stay, increased hospital costs and an enterocutaneous fistula. To improve the chances of correct diagnosis at initial admission, accurate menstrual and sexual history should be obtained. Facilities for improved diagnosis such as serum beta HCG and transvaginal ultrasonography should be provided. Colleagues from other specialities should be educated to increase their suspicion of ectopic pregnancy in any woman of childbearing age and perform the appropriate investigations.

Misdiagnosed Uterine Rupture of an Advanced Cornual Pregnancy

“…An early diagnosis of ectopic pregnancy is important as a delay in the correct diagnosis is known to increase the risk of maternal morbidity and mortality [14]. …”

Profile of Ectopic Pregnancy in Tertiary Level Hospital in Uttarakhand, India

“…Amenorrhoea and vaginal bleeding were other common clinical presentation [23] [27]. However some studies have shown that about 10% -20% of ectopic pregnancies may present without vaginal bleeding [19]. There are no specific clinical feature that is pathognomic for ectopic pregnancy.…”

A Retrospective Study on Risk Factors and Clinical Presentation of Ectopic Pregnancy

“…Vaginal bleeding was observed in 25% cases. Orji et al [16] in a study have shown that about 10-20% of ectopic pregnancies may present without vaginal bleeding. There are no specific symptoms or signs that are pathognomonic of ectopic pregnancy.…”